[A script to replicate the analysis in R is included in the supplementary materials.]
A methodological paradox characterizes macro-comparative research: it routinely violates the assumptions underlying its dominant method—multiple regression analysis. Comparative researchers have substantive interest in cases, but cases are largely rendered invisible in regression analysis. Researchers seldom recognize the mismatch between the goals of macro-comparative research and the demands of regression methods, and sometimes they end up engaging in strenuous disputes over particular variable effects. A good example is the controversial relationship between income inequality and health. Here, we offer an innovative method that combines variable-oriented and case-oriented approaches by turning OLS regression models “inside out.” We estimate case-specific contributions to regression coefficient estimates. We reanalyze data on income inequality, poverty, and life expectancy across twenty affluent countries. Multiple model specifications are primarily dependent on two countries with values on the outcome that are extreme in magnitude and inconsistent with conventional theoretical expectations.
Suicide is one of the leading causes of death in the United States. The rise in suicide rates is contributing to the recently observed decline in life expectancy. While previous research identified a solid association between economic strain and suicide, little attention has been paid to how specific welfare policies that are designed to alleviate economic strain may influence suicide rates. There is a growing body of research that is using an institutional approach to demonstrate the role of welfare-state policies in the distribution of health. However, this perspective has not been applied yet to the investigation of suicide. In this study, I combine these approaches to analyze the association between two specific policies, Supplemental Nutrition Assistance Program (SNAP) and Earned Income Tax Credit (EITC), and overall and gender-specific suicide rates across the 50 U.S. states between 2000 and 2015. I estimate two-way fixed-effects longitudinal models and find evidence of a robust association between one of these policies – SNAP – and overall and male suicide. After adjusting for a number of confounding factors, higher participation in SNAP is associated with lower overall and male suicide rates. Increasing SNAP participation by one standard deviation (4.5% of the state population) during the study period could have saved the lives of approximately 31,600 people overall and 24,800 men.
Recently, much scholarly work has been conducted examining the effect of rising income inequality on health outcomes. However, this work is somewhat inconclusive. Chiefly, the mechanisms which could produce such an association are still being sorted out. Further, much of this work is focused on mortality outcomes with little attention to how this process operates for actual health conditions, including chronic health problems, which are arguably now the main public health concerns of the developed world. In this study, in a series of multilevel binary logistic regression models using data from the 2005 and 2007 Behavioral Risk Factor Surveillance System (BRFSS), we examine the association between state-level income inequality, poverty, and social welfare measures on spending and policy to examine the association between these factors for three chronic health outcomes: diabetes, hypertension, and coronary heart disease. We find that income inequality is only conditionally positively related to the diagnosis of two of the three outcomes, diabetes and hypertension, and only in 2007. However, absolute poverty is related to the outcome across all three dependent variables. Additionally, certain social welfare measures attenuate the effects of both income inequality and absolute poverty, suggesting that certain welfare policies reduce this association.
Advancement in medical science and technology enhanced the human capacity to intervene in the process of dying, forcing professionals and the public to face ethical dilemmas and question the boundary between life and death. The contentious discourse on this boundary is particularly salient given the unprecedented levels of population aging all over the world. This paper analyzes the discursive field surrounding a notable Italian end-of-life controversy. Combining field and narrative theories, the present study spans structural aspects and rhetorical mechanisms. Results show that not only are antithetical interpretations of the event tied to media’s ideological leanings, but the latter are also systematically associated with different sequential structures of headlines and story leads. Competing actors produce alternative frameworks by identifying different sets of perpetrators.
The publication of The Spirit Level (Wilkinson and Pickett, 2009) marked a paramount moment in the analysis of health and inequality, quickly attracting a remarkable degree of attention, both positive and negative, both in academic and in public discourse. Following at least 20 years of research, the book proposes a simple and powerful argument: inequality per se, more specifically income inequality, is harmful to every aspect of social life. In order to confirm this idea, the authors present a series of bivariate, cross-sectional associations showing comparisons across countries and within the United States. Despite the methodological limitations of this approach, the authors advance causal claims concerning the detrimental effects of income inequality. They also rule out poverty as a plausible alternative explanation, without directly measuring it. Meanwhile, over the last decade stratification scholars have demonstrated the nonlinear effect of economic factors, especially income, on health. The results suggest that a relative approach is best for analyzing dynamics at the top of the income distribution, whereas an absolute approach seems most appropriate for studying the bottom of the distribution. Consistent with this perspective, here I reanalyze data from The Spirit Level, adding a measure of poverty, in order to control the effect of inequality and explore its interaction with poverty. The findings show that inequality and poverty—which I contend are two interdependent but nonetheless distinct phenomena—interact across countries, such that the detrimental effects of inequality are present or stronger in countries with high poverty, and absent or weaker in countries with low poverty; poverty replaces inequality as the favored explanation of health and social ills across states. The new evidence suggests that income distributions are characterized by a complex interplay between inequality and poverty, whose interaction deserves further analysis.
[Excerpt] To conclude, I emphasize that none of the points raised here and in the original article are incompatible with the fact that excessive income inequality has adverse social effects, with the existence of social gradients, or with psychological explanations. However, as we look at the bigger picture and analyze it in its complexity, we should strive to avoid reductionism. There is an “enormous and well-developed body of social science literature” (Beckfield & Krieger, 2009, p. 153) that can help shed light on the structural side of this story, which until now has been too readily dismissed.
In Italian. Tr.: “The Cracked Mirror: Political Language and Democracy”